CMS Issues 2023 Physician Fee Schedule Proposed Rule

On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2023. Arguably the most noteworthy provision in the proposed rule is the agency’s suggested cut to physician payments. However, the rule also includes a number of other policy proposals, including changes to Medicare accountable care organizations (ACOs), behavioral health care, cancer screening, and dental care. (Read more...)

2023 OPPS Proposed Rule Released

On July 15, 2022, CMS released the proposed rule for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Centers (ASCs) for CY 2023. The agency proposes an increase in payments to outpatient providers and offers insight on the new rural emergency hospital program, as well as to how it might respond to the recent U.S. Supreme Court decision on the 340B Program. (Read more...)

Coordinated Actions Indicate Growing Scrutiny of Telemedicine

On July 20, 2022, the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) released a Special Fraud Alert on telemedicine. On the same day, the U.S. Department of Justice (DOJ) announced a “nationwide coordinated law enforcement action” against 36 defendants, and the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity announced administrative actions against 52 providers, related to alleged telemedicine arrangements. These coordinated actions indicate a growing scrutiny of telemedicine arrangements by federal government regulators. (Read more...)

Valuation of Remote Therapeutic Monitoring: Introduction

RTM, formally called Remote Therapeutic Monitoring / Treatment Management, “encompasses the collection and monitoring of therapy adherence and therapy response data along with treatment management services.” The RTM concept was created in October 2020 by the Current Procedural Terminology (CPT) Editorial Panel. RTM consists of five general medicine CPT codes, which were created in order to fill in some of the “noteworthy gaps that exist in the current coverage and delivery of [remote patient monitoring]….[and] help patients experience more consistency and quality along the continuum of care, especially in the realm of chronic disease monitoring.” (Read more...)